California Gov. Gavin Newsom last year vetoed Assembly Bill 2236 that would have granted optometrists in the Golden State the ability to perform a variety of anterior segment lasers, injections and even scalpel procedures, all with minimal additional training.
Although optometrists play an important role in primary eye care health, had it passed, the legislation would have significantly reduced surgical licensing requirements and presented a threat to patient safety.
I was part of the effort to fight the bill. Being a trainee offered me an advantage talking with legislators who were willing to listen. And because I was learning these procedures in real time, I could speak to the graded supervision and minimum numbers required to confidently perform them independently.
As Gov. Newsom astutely noted in his veto letter, a proposed 32-hour-long weekend course for optometrists on performing laser procedures provided insufficient education and training relative to the required and extensively supervised three-plus years of ophthalmology residency. Ophthalmologists must learn the indications and alternatives to such procedures, in addition to how to perform them, oversee the postoperative period and manage unforeseen complications.
When they learned of the bill’s progress in the legislature, the Academy, California Academy of Eye Physicians and Surgeons (CAEPS), California Medical Association (CMA) and American Medical Association (AMA) quickly sprang into action to shed light on the dangers of this bill and outlined the clear threat to patient safety.
In addition to highlighting the vast discrepancies in surgical training, CAEPS and the Academy quickly mobilized our collective ophthalmology members to note other pitfalls of the bill, including the lack of urgency for all the procedures optometrists would be granted. Many patients can safely wait to be referred to an ophthalmologist for these procedures, we said. We took care to highlight low minimum numbers for proficiency of each procedure, lack of education on managing long-term consequences or complications and management of unique and complex medical needs of certain patients, particularly seniors and children.
By organizing the voices of ophthalmologists, CAEPS, the Academy and the CMA expressed the collective concerns of California ophthalmologists about the legislation’s flaws. We spurred a grassroots activism that led medical societies, practices, individual ophthalmologists and even a former optometrist to speak for patient safety and advocate against lowering training requirement standards for ophthalmologic procedures.
As a young ophthalmologist, I immediately reached out to my co-residents and other residents in my state urging them to call and discuss just how challenging it is to learn these procedures, as well as to manage them postoperatively when complications arise. YOs offer an important perspective and a voice for legislators.
Why and How to Get Involved
Surgical scope-of-practice battles will continue to emerge and challenge the standards of safe surgery by threatening to remove ophthalmologists from the eye care team. Although California was able to secure a veto in the 11th hour, it is frightening just how close this dangerous bill was to becoming law.
That’s why I urge YOs to advocate for protecting patient safety early on in their careers. YOs can play a crucial role in preserving the quality of care and championing the interests of our patients and ophthalmology. Advocacy starts before any bills are introduced, and it is important that YOs get involved early on in their careers to maintain the standard of care and ensure surgery is done by surgeons.
5 Steps to Advocacy
- A great first step is simply to discuss the importance of advocacy with your colleagues and how decreasing training standards pose a substantial risk to patient safety.
- Be aware of scope-of-practice bills in your state and discuss the legislation and its effect on patient safety with your colleagues and family.
- Stay up to date on local legislation by joining your state ophthalmology society and look out for emails regarding scope-of-practice bills or a need for volunteers.
- Reach out to your state society and see if they will sponsor you to attend your state’s legislative day on Capitol Hill.
- Get involved at both the state and national level is attending the Academy’s Mid-Year Forum in Washington, DC. For me, it was one of the most interesting conferences I have attended and a great way to learn about important legislation, build a foundation with legislators for future battles and connect with other advocacy-oriented colleagues.
By taking proactive measures, YOs can become strong advocates for our patients and contribute to maintaining the quality of surgical eye care provided.
||About the author: Kendall Goodyear, MD, is a PGY3 at the Jules Stein Eye Institute, University of California, Los Angeles. Dr. Goodyear was sponsored by the California Academy of Eye Physicians and Surgeons to attend the Academy’s Mid-Year Forum 2023 via the Advocacy Ambassador Program.